Browsing by Author "OʼBrien, Michael"

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    Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.
    (Spine, 2013-05) Hostin, Richard; McCarthy, Ian; OʼBrien, Michael; Bess, Shay; Line, Breton; Boachie-Adjei, Oheneba; Burton, Doug; Gupta, Munish; Ames, Christopher; Deviren, Vedat; Kebaish, Khaled; Shaffrey, Christopher; Wood, Kirkham; Hart, Robert; International Spine Study Group

    Study design

    Multicenter, retrospective series.

    Objective

    To analyze the incidence, mode, and location of acute proximal junctional failures (APJFs) after surgical treatment of adult spinal deformity.

    Summary of background data

    Early proximal junctional failures above adult deformity constructs are a serious clinical problem; however, the incidence and nature of early APJFs remain unclear.

    Methods

    A total of 1218 consecutive adult spinal deformity surgeries across 10 deformity centers were retrospectively reviewed to evaluate the incidence and nature of APJF, defined as any of the following within 28 weeks of index procedure: minimum 15° post-operative increase in proximal junctional kyphosis, vertebral fracture of upper instrumented vertebrae (UIV) or UIV + 1, failure of UIV fixation, or need for proximal extension of fusion within 6 months of surgery.

    Results

    Sixty-eight APJF cases were identified out of 1218 consecutive surgeries (5.6%). Patients had a mean age of 63 years (range, 26-82 yr), mean fusion levels of 9.8 (range, 4-18), and mean time to APJF of 11.4 weeks (range, 1.5-28 wk). Fracture was the most common failure mode (47%), followed by soft-tissue failure (44%). Failures most often occurred in the thoracolumbar region (TL-APJF) compared with the upper thoracic region (UT-APJF), with 66% of patients experiencing TL-APJF compared with 34% experiencing UT-APJF. Fracture was significantly more common for TL-APJF relative to UT-APJF (P = 0.00), whereas soft-tissue failure was more common for UT-APJF (P < 0.02). Patients experiencing TL-APJF were also older (P = 0.00), had fewer fusion levels (P = 0.00), and had worse postoperative sagittal vertical axis (P < 0.01).

    Conclusion

    APJFs were identified in 5.6% of patients undergoing surgical treatment of adult spinal deformity, with failures occurring primarily in the TL region of the spine. There is evidence that the mode of failure differs depending on the location of UIV, with TL failures more likely due to fracture and UT failures more likely due to soft-tissue failures.
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    ItemOpen Access
    Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up.
    (Neurosurgery, 2016-06) Smith, Justin S; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; OʼBrien, Michael; Boachie-Adjei, Oheneba; Akbarnia, Behrooz A; Mundis, Gregory M; Errico, Thomas; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Sciubba, Daniel; Ailon, Tamir; Fu, Kai-Ming G; Kelly, Michael P; Zebala, Lukas; Line, Breton; Klineberg, Eric; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Doug; Bess, Shay; Ames, Christopher P; International Spine Study Group

    Background

    High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed.

    Objective

    To compare outcomes of operative and nonoperative treatment for ASD.

    Methods

    This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence-to-lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up.

    Results

    Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P < .001) and had worse deformity based on pelvic tilt, pelvic incidence-to-lumbar lordosis mismatch, and sagittal vertical axis (P ≤ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P < .001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P < .001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P < .001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications.

    Conclusion

    Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability.

    Abbreviations

    ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisMCID, minimal clinically important differenceNRS, numeric rating scaleODI, Oswestry Disability IndexPI, pelvic incidenceSF-36, Short Form-36SRS-22r, Scoliosis Research Society-22rSVA, sagittal vertical axis.
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    Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients.
    (Neurosurgery, 2016-09) Smith, Justin S; Ramchandran, Subaraman; Lafage, Virginie; Shaffrey, Christopher I; Ailon, Tamir; Klineberg, Eric; Protopsaltis, Themistocles; Schwab, Frank J; OʼBrien, Michael; Hostin, Richard; Gupta, Munish; Mundis, Gregory; Hart, Robert; Kim, Han Jo; Passias, Peter G; Scheer, Justin K; Deviren, Vedat; Burton, Douglas C; Eastlack, Robert; Bess, Shay; Albert, Todd J; Riew, K Daniel; Ames, Christopher P; International Spine Study Group

    Background

    Few reports have focused on treatment of adult cervical deformity (ACD).

    Objective

    To present early complication rates associated with ACD surgery.

    Methods

    A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees.

    Results

    Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007).

    Conclusion

    This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care.

    Abbreviations

    3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis.
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    ItemOpen Access
    Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis.
    (Spine, 2014-06) Kim, Han Jo; Boachie-Adjei, Oheneba; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Bess, Shay; Gupta, Munish C; Smith, Justin S; Deviren, Vedat; Akbarnia, Behrooz; Mundis, Greg M; OʼBrien, Michael; Hostin, Richard; Ames, Christopher; International Spine Study Group

    Study design

    Retrospective review-multicenter database.

    Objective

    The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) upper instrumented vertebrae (UIV) in long fusions to the sacrum for adult scoliosis.

    Summary of background data

    The optimal UIV for stopping long fusions to the sacrum/pelvis are controversial. Although a UT endpoint may lead to greater operative times, blood loss, and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis and need for revision surgery is likely lower.

    Methods

    Retrospective analysis of a prospective database of patients with adult spinal deformity, Patients were selected on the basis of fusions to the sacrum/pelvis with UIV of T1-T6 (UT group) and those with a UIV of T9-L1 (LT group). Demographic data, operative details, and radiographical outcomes with Scoliosis Research Society scores, and Oswestry Disability Index outcomes were collected, as well as complication data were compared. The Fisher exact T tests were used for statistical analysis.

    Results

    A total of 198 patients (UT = 91, LT = 107) with a mean age of 61.6 were followed for an average of 2.5 years. Demographic variables were similar between the groups except for larger numbers of females in the UT group and a slightly higher body mass index in the LT group. Preoperatively, the UT group demonstrated significantly more lumbar scoliosis, thoracic scoliosis, and thoracolumbar kyphosis. The UT group demonstrated a larger number of fused segments length of stay and longer operative times. There was slightly larger volume of blood loss in the UT group.The total number of complications and number of revision surgical procedures were similar between the groups. The UT group had a higher percentage of patients with 2 or more complications. Both groups had similar proximal junctional kyphosis angles and number of cases requiring revision for proximal junctional kyphosis. Scoliosis Research Society and Oswestry Disability Index outcomes were similar between the groups.

    Conclusion

    The UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The length of stay and operative times were higher in the UT group but may have been necessarily evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.

    Level of evidence

    4.